Health and Social Care Bill

My Lords, I have a great deal of sympathy with the amendment. When I first worked in a hospital in 1974, the Nuffield Orthopaedic Centre in Oxford, we had a private patients' ward called Mayfair. The succession of senior consultants, the head OT and head physio, gave me an impression of the priority that was given. There will always be debate about the phasing out of paid beds—this was the case even under Barbara Castle—but some of it arises from real concerns over differentiation in equity of treatment. I take the amendment to be very focused on the board of an NHS foundation trust, not on individual clinicians. It is an important safeguard regarding the way in which the board of a foundation trust may wish to deal with the financial pressures that it is under. We should not be under any doubt, and I speak as an FT chair, that many foundation trusts are facing financial pressures alongside the rest of the NHS. They are required to make efficiency savings and, probably, to move resources from acute hospitals into primary care without any reassurance that primary care is going to demand-manage. There is a real worry that GPs will give more money to themselves but with no guarantee that that will impact on the flow of patients through acute hospitals. There is concern that the pressure on acute hospitals, instead of reducing, which we would like to see, will actually grow. If, with the 49 per cent cap that we now have, there are opportunities for private patient practice, some boards will very much want to take advantage of that. The problem is that those boards, when faced with real financial difficulty, may put undue pressure on their clinicians. I am always in favour of protecting clinicians in these circumstances, and the amendment is very welcome in giving a clear indication to the boards of foundation trusts that they must not put undue pressure on clinicians with regard to this tricky issue of the relationship between private patients and public NHS patients.